Chances are you know a woman who has suffered from postpartum depression. But chances are she’ll never tell you.

Postpartum depression (known as PPD) and the taboo surrounding it have been getting a lot of press lately, as evidenced by a recent New York Times series on the subject, and as researchers slowly discover just how many causes and symptoms may be involved.

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Some now prefer the term “maternal mental illness,” to capture the vast array of symptoms and not confuse the distinct types of mental disorders women may suffer from after birth. These can range from anxiety or depression to bipolar symptoms and severe psychosis—and sometimes they can even begin during pregnancy.

The causes are likely just as varied. Previous forms of depression, outside stress factors, fluctuating hormones as a result of pregnancy, trouble breast-feeding and caring for a child, or trauma from a past miscarriage or abortion can all play a role in developing PPD.

According to one study, a fifth of all women will experience some form of depression in the year after giving birth. Half of these cases will involve what’s considered "serious" symptoms. And because women sometimes believe what they have is just the "baby blues," a common temporary and less serious experience, many cases of PPD are never identified.

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When mental illnesses start to come into the public light like this, “national conversations” and greater openness often follow. But how does a woman actually living with PPD tell her friends and family that the infant she wanted to bring into the world has brought darkness into her life?

Jean’s daughter was born in the summer of 2012, right after moving across the country so her husband could accept a new job at a university. She had a good birth experience, and at first felt physically fine.

But soon the hormones kicked in, and Jean found herself constantly weeping. She felt unshakably anxious about the baby, and would not allow herself to sleep. Instead she lay awake worrying, “zoning out” in exhaustion.

Her daughter had trouble breast-feeding, and couldn’t gain enough weight. Determined not to give up, Jean pushed herself to keep up with a strict regimen of pumping breast milk. This left her in “emotional and physical pain,” but for a while she was able to ignore the feeling that something was wrong.

Looking back, she realizes that, buried beneath the stress, she felt numb. “When my daughter needed me I was there, I was present for her, but the rest of the time I was just kind of like a zombie.”

Before the pregnancy she had been very active, teaching Pilates, swimming, doing yoga. Now she felt “listless,” and her mother began to notice. She encouraged her to get out more.

She joined mothers groups, but felt uncomfortable opening up about what she was going through. “That would be admitting I was failing,” she says. “I was afraid that everyone was doing better than I was.”

At one point, she says, “It was like my body was acting completely separate—I had no control over what was going on.”

Jean finally broke down in her pediatrician’s office, after learning that, at four months, her daughter had dropped off the growth curve for infants her age.

She became hysterical. “I had been trying so hard; I had been working so hard,” and she had been living for months with anxiety and panic over her daughter’s health.

The pediatrician recommended she get help—both for her daughter and for herself. She began to see a psychologist and later a psychiatrist.

She went on the anti-depressant Zoloft for over a year. Her mental health gradually improved, and she slowly stopped using the medication. Her daughter has just turned two.

She credits her depression partly to being alone and overwhelmed in a new place. “I didn’t have that feeling of being a part of anything, I was just floating in this new city.”

Jean still rarely discusses her PPD. “It’s tough,” she says. “Because it’s not like I’ve never been depressed before, but this was different. There’s kind of a shame attached—feeling like you’re failing at being a mother.

She sometimes talks to friends who are pregnant, to tell them if they experience something similar, there are resources for them and ways to get through it.

But relating to other young mothers can be complex. One of her friends recently had a baby, and Jean went to visit her at the hospital—the same hospital in which she had given birth. As soon as she set foot in there, the unpleasant memories came flooding back. She can’t tell her friend that seeing her new infant fills her with dread.

Nikki Wray is a postpartum doula who helps new mothers in their homes, providing education and assistance in caring for a newborn. Support from outside resources like a doula are thought to reduce the incidence of PPD. She says about 25 percent of her clients come to her because they have had PPD or some other form of depression in the past.

One of her first clients was a mother of twins who had experienced some complications during the birth. Wray met her when she came home from the hospital. Within an hour, the mother was suffering from an anxiety attack, shaking and telling Wray, “I think I’m going to die, I think I’m dying.”

At times, she would tell Wray she had no concept of days passing— “It’s light out, and then it’s dark out, and then it’s light out, and then it’s dark out.”

But even with a doula, trained to support women through the postpartum period, not all women are comfortable revealing their anxieties. With one client, Wray would only find out later that she had had PPD in the past and had never told her. “She was ashamed I guess.”

Wray says some mothers may struggle because they don’t have enough support, as mothers are more and more likely to raise children far from their mothers and other female family members who can tell them what a normal infancy is like. They have no one to tell them even simple things, like how long their baby should sleep through the night.

Some women worry that if they seek medical help for their depression, they’ll be prevented from breast-feeding, so Wray assures them there are anti-depressants and anxiety drugs that can be taken while breast-feeding. She encourages them to seek medical treatment if they need it, and to let others help them when they're overwhelmed.

“They don’t know if they’ll be able to eat today or take a shower today,” says Wray. Sometimes, she says, “You just need someone to cook you a meal and hold the baby for an hour while you sleep.”

Priscilla Bier does volunteer counseling for PPD and worked for a time at a hospital helping with a PPD support group. She says awareness about PPD has come a long way in recent years—there was a time when doctors were reluctant to diagnose it, and few people knew what it was.

She encourages women to line up support during their pregnancies. Many women feel they should be able to handle a newborn on their own, but, she says, “We’re not made to be independent—we’re made for grandma to be there.” Even hiring the teenager next door to help out with chores could make a world of difference.

Alexandra had her second child, a daughter, thirteen months to the day after her first. She had just moved to a new city, and found herself with an infant and a child not old enough to walk. Her husband was in school, and her family was far away.

Simple tasks, like going to the grocery store, were suddenly daunting with two very young children in tow and a city to navigate by foot.

Six weeks after her daughter’s birth, right after her mother and mother-in-law had ended their visits to help her, Alexandra woke up one morning unable to walk. She was diagnosed with an auto-immune disease.

For months she dealt with fear and depression as she sorted out the diagnosis of her disease. She was only 25, and wondered if she would ever be able to walk again or care for her children.

At first she tried to brush off her depression as stress from her disease, but after several months she realized something else was wrong. “I felt like I had become a burden, being sick, and that I was hurting my kids more than helping them. I was feeling like they would be better off if I wasn’t their mother.”

Alexandra felt worthless and knew something outside her was manipulating her emotions.

She had blood work done, and discovered her progesterone was dangerously low. She began receiving progesterone shots and seeing a therapist, and felt an improvement within just a month.

The therapy was healing. She needed someone to tell her that her work, “even when it was hindered by what was going on with me, was still valuable to my family, and I was still worthy of getting myself better.”

For her third child, Alexandra and her husband had moved to the Midwest, and her autoimmune disease was more under control. Her youngest child was older. She says it was an “amazing experience, very life-giving,” to remember that birth could still be joyful.

She also hired help to watch her kids occasionally. It encouraged her to improve her health. “It felt like an investment. It felt like a sacrifice we were making in honor of my health.”

Alexandra says it was difficult for her to tell others about her PPD. “I had things like suicidal thoughts, which felt shameful to me.”

She says it was hard for some of her friends to understand, particularly since many were single. Months after she recovered, she finally told her mother—only to learn her mother had also once experienced PPD.

Stunned that someone so close to her had silently gone through the same things, she decided it was important to share her experience with other women. Now women regularly approach her privately to ask about how to cope with PPD. One woman, she recalls, whom she had long admired as a mother, came to her while struggling with PPD, for the first time, after her seventh birth.

As difficult as it is to approach, Alexandra says, women need to know that they can survive their depression. “Because when you’re so deep in it, it feels like you can’t even survive until dinner.”

There will probably never be one simple answer to how a woman should talk about PPD. National conversations can raise general awareness, but most of the real work will be done by young mothers like Jean and Alexandra, in quiet conversations, one person at a time.